Category: Access to Care

“Republicans’ strong showing in this week’s mid-term elections opens the door to more calls to repeal President Obama’s signature law, the Affordable Care Act.
And while that is all but impossible given the balance of power in the U.S. Senate, victories in Washington and at the state level could usher in other healthcare changes.”

“Tuesday’s re-election of Republican governors in closely contested races in Florida, Georgia, Wisconsin, Maine and Kansas dims the chances of Medicaid expansion in those states.
Advocates hoping for Democratic victories in those states were disappointed by the outcomes, but Alaska, which also has a Republican incumbent, remains in play as an independent challenger holds a narrow lead going into a count of absentee ballots.”

“Since enactment of the Affordable Care Act (ACA) in 2010, much of the attention in the policy community has been on modernizing Medicare’s traditional fee-for-service (FFS) program. Through Accountable Care Organizations (ACOs), larger “bundles” of payments to fee-for-service providers for episodes of care, and tests of pay-for-performance models, the hope is that the traditional Medicare model can be remade through sheer force of bureaucratic will. The stated intent is to find a way to pay for value, not volume.
These efforts may or may not bear much fruit, but, over the longer term, it’s not likely to matter much. That’s because a more important transformation of Medicare is already well underway and is occurring despite more resistance than assistance from the program’s bureaucracy. According to the 2014 Medicare Trustees’ report, enrollment in Medicare Advantage – the private plan option in Medicare — has been surging for a decade. In 2005 there were 5.8 million Medicare beneficiaries enrolled in MA plans — 13.6 percent of total enrollment in the program. Today, there are 16.2 million beneficiaries in MA plans, or 30 percent of program enrollment. (See Table IV.C1) In addition, the Medicare drug benefit, which constitutes about 12 percent of total program spending, is delivered entirely through private plans.”

“Tuesday’s re-election of Republican governors in closely contested races in Florida, Georgia, Wisconsin, Maine and Kansas dims the chances of Medicaid expansion in those states.
Advocates hoping for Democratic victories in those states were disappointed by the outcomes, but Alaska, which also has a Republican incumbent, remains in play as an independent challenger holds a narrow lead going into a count of absentee ballots.
“No one would say it was a good night for the prospects of Medicaid expansion,” said Joan Alker, executive director of the Center for Children and Families at Georgetown University.”

“The Obama administration plans to close a loophole in the Affordable Care Act that allows large companies to refuse to cover in-patient hospital stays in any of their health insurance plans, according to an official involved in the internal discussions.
The official requested anonymity until the announcement is made because “the guidance that will be issued is not finalized.””

“A lot of attention has been paid to what a shift in control of the Senate in the midterms might mean for the Affordable Care Act and other big policy issues. As ACA implementation has shifted to the states, governor’s races may be just as important, particularly when it comes to whether states expand Medicaid.
Six of the 23 states that have not expanded Medicaid have toss-up governor’s races: Alaska, where Republican incumbent Sean Parnell is running against independent Bill Walker; Florida, the most closely watched race, where former governor Charlie Christ, now running as a Democrat, is trying to unseat Republican Gov. Rick Scott; Georgia, where incumbent Republican Nathan Deal is trying to hold off Democratic state legislator Jason Carter; Kansas, where state legislator Paul Davis is challenging Gov. Sam Brownback; and Wisconsin, where Gov. Scott Walker is being challenged by Mary Burke; and Maine, where Democratic state legislator Mike Michaud and independent Eliot Cutler are running against Gov. Paul LePage.”

“Health insurers increasingly are building and staffing bricks-and-mortar retail centers to potentially expand their membership base and, most importantly for now, enhance their brand image with the public.
The retail approach represents a major pivot in insurer tactics to grow their books of business brought on by changes in how consumers get insurance thanks to the Patient Protection and Affordable Care Act.”

“When Tony Smith lost his job as a corporate paralegal two years ago, a state program stepped in to help him keep his health insurance — and the expensive drugs his life had depended on since his 2008 HIV diagnosis.
Now Smith, 42, of Coral Springs, has been told he must sign up for coverage on Florida’s federally run insurance exchange or the state will stop helping him pay his premiums.
“The landscape of healthcare has changed, and with the passage of the Affordable Care Act we have the opportunity to access and enroll in cost-effective health plans,” an official at the AIDS Insurance Continuation Program wrote in a letter to Smith and other AICP beneficiaries.
But it is not clear that ACA insurance plans will be cheaper — or even affordable — for those with HIV and AIDS, according to patient advocates.”

“Get ready to be inundated with a fresh round of Obamacare propaganda. President Obama’s health care law will be back in the news next month when open enrollment begins Nov. 15. The government is already gearing up to recruit more enrollees.
But based on what we know already, the Affordable Care Act isn’t panning out exactly as expected. That’s because the vast majority—an estimated 71 percent—of people who gained coverage under Obamacare between January and June did so by qualifying under Medicaid’s loosened eligibility requirements.”

“A federal judge in Florida on Tuesday jumped into the latest round in the legal wrangling over a Patient Protection and Affordable Care Act provision involving birth-control coverage and how it applies to religious institutions.
U.S. District Judge James Moody Jr. temporarily blocked the federal government from enforcing on a Roman Catholic college a new workaround HHS had developed on the thorny issue.”